PMID: 9188977Jun 1, 1997Paper

Free tissue transfer in treatment of the recalcitrant chronic venous ulcer

Annals of Plastic Surgery
N Weinzweig, J Schuler

Abstract

We propose that a long-term cure for the recalcitrant chronic venous ulcer must involve a dual surgical approach including (1) wide excision of the ulcer and surrounding liposclerotic tissue bed, and (2) replacement by a free flap containing multiple, competent microvenous valves with a normal microcirculation. Advantages of free flaps over skin grafting include improvement of the underlying pathophysiology; increase in blood supply to the area; ability to cover exposed bone, joint, or tendon; and a lower incidence of recurrence. During the past 8 years, 20 consecutive muscle free flaps were performed in 18 patients for 19 recalcitrant venous ulcers (two "sequential" flaps to the ipsilateral leg in 1 patient and a repeat flap after initial failure in 1 patient). Twelve males and 6 females ranged in age from 17 to 76 years (mean, 44 years). Nontraumatic, nonosteomyelitic venous ulcers had been present for an average of 3.5 years (range, 1-10 years) and failed an average of 2.4 skin grafts (range, 0-6 grafts). Defects ranged from 100 to 600 cm2 (mean, 238 cm2). Donor tissues included rectus abdominis (N = 13), latissimus dorsi (N = 5), gracilis (N = 1), and serratus (N = 1) muscles. Recipient vessels included posterior tibial (N ...Continue Reading

Citations

Mar 12, 1999·Cardiovascular Surgery : Official Journal of the International Society for Cardiovascular Surgery·F T Padberg
Mar 26, 2014·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Catherine de BlacamBernard T Lee
May 16, 2008·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·T KremerG A Giessler
Mar 1, 2011·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·M A A KhanW Jaffe
Oct 31, 2007·Clinics in Plastic Surgery·William Marston
Oct 29, 2000·Journal of Vascular Surgery·N H KuminsJ J Schuler
Jul 22, 2005·Annals of Plastic Surgery·Husamettin TopMedeni Kiyak
Feb 24, 2001·Journal of the American Academy of Dermatology·I C ValenciaW H Eaglstein

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